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Background Release Form Disclosure and Consent

The document is a background release form for a job applicant to disclose and consent to an investigation into their background for employment purposes. It allows the company to obtain consumer and investigative reports that include information about the applicant's character, reputation, personal characteristics, lifestyle, work habits, and performance from previous employers. It also allows the company to request additional consumer reports during the course of employment to determine ongoing suitability. The applicant can revoke consent at any time by sending a letter to the company.

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alexchaverri
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48 views

Background Release Form Disclosure and Consent

The document is a background release form for a job applicant to disclose and consent to an investigation into their background for employment purposes. It allows the company to obtain consumer and investigative reports that include information about the applicant's character, reputation, personal characteristics, lifestyle, work habits, and performance from previous employers. It also allows the company to request additional consumer reports during the course of employment to determine ongoing suitability. The applicant can revoke consent at any time by sending a letter to the company.

Uploaded by

alexchaverri
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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Background Release Form

Disclosure and Consent


In connection with my application for employment (including contract for service) with COMPANY
(the company), I understand that investigative inquiries may be obtained on myself by a consumer
reporting agency, and that any such report will be used solely for employment-related purposes. I
understand that the nature and scope of this investigation will include a number of sources including,
but not limited to, consumer credit, criminal convictions, motor vehicle, and other reports. These
reports will include information as to my character, general reputation, personal characteristics, mode
of living and work habits. Information relating to my performance and experience, along with reasons
for termination of past employment from previous employers, may also be obtained.
I understand that if the Company hires me, it may request a consumer report or an investigative
consumer report about me for employment-related purposes during the course of my employment.
The scope of this investigation will be the same as the scope of a pre-employment investigation, and
that the nature of such an investigation will be my continuing suitability for employment, or whether I
possess the minimum qualifications necessary for promotion or transfer to another position. I
understand that my consent will apply throughout my employment, unless I revoke or cancel my
consent by sending a signed letter or statement to the Company at any time, stating that I revoke my
consent and no longer allow the Company to obtain consumer or investigative consumer reports
about me.
This Disclosure and Consent form, in original, faxed, photocopies or electronic form will be valid for
any reports that may be requested by the Company. I acknowledge that my personal information
may be transferred back to the given country and I give my consent for such release of personal
information in accordance with local Data Protection (privacy) laws.
I authorize without reservation any party or agency acting on the behalf of this employer to furnish
the above-mentioned information. I understand to aid in the proper identification of my file or record
the following personal identifiers, as well as other information, is necessary.

Print Name: ____________________________


Other Names Known by: ____________________________________
Government Identification Number: ____________________
Current address: ___________________
City: _____________Province: ____________
Country: ____________________________________________
Signature: _____________________________________________________
Date: __________________________________________________________

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